Healthcare Provider Details

I. General information

NPI: 1710813779
Provider Name (Legal Business Name): ROSSI RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 REGENCY PATH DR
DECATUR GA
30030-4168
US

IV. Provider business mailing address

2119 PENELOPE ST NW
ATLANTA GA
30314-1513
US

V. Phone/Fax

Practice location:
  • Phone: 706-572-4591
  • Fax:
Mailing address:
  • Phone: 718-971-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: